b. Lateral Epicondylitis (Tennis Elbow)

What is Lateral Epicondylitis (Tennis Elbow)?

Tennis elbow is a condition characterized by pain and tenderness on the bony prominence on the outside of the elbow. The elbow joint is located between the upper arm bone, called the humerus, and the lower arm bone called the ulna. The bony prominences at the lower part of the humerus are called epicondyles. The outer one is known as the lateral epicondyle, and this is where the tendons of some forearm muscles attach. Tennis elbow is a result of overuse of the forearm muscles that straighten and raise the hand and wrist. When these muscles are overused, the tendons repetitively pull at their attachment point, the lateral epicondyle. Consequently, there is a reaction and swelling in the tendons. Repeated tiny tears in the tendons create pain. Activities that can cause tennis elbow include tennis and other racquet sports, carpentry, machine work, extensive typing, and knitting.

What are the symptoms of tennis elbow?

• Pain and tenderness on the outer side of the elbow
• Pain during straightening or lifting the hand and wrist
• Increased pain when lifting heavy objects
• Pain during making a fist, handshaking, grasping an object, or turning doorknobs
• Pain that radiates from the elbow to the forearm or upper arm

How is it treated?

• Ice is applied to the elbow for 20-30 minutes every 3-4 hours for 2-3 days until the pain subsides.
• A special elbow strap for tennis elbow may be provided. This strap wraps around the forearm just below the elbow and helps to prevent the forearm muscles from pulling on the painful epicondyle.
• Pain relievers and anti-inflammatory medications are prescribed. Physical therapy and a regular exercise program are significantly beneficial.
• Cortisone injections around the lateral epicondyle can be helpful. If conservative methods do not relieve pain, cortisone injections around the medial epicondyle can be considered.

Tennis Elbow Injection

How is a cortisone injection administered, and how does it work?

A depot cortisone and local anesthetic mixture is injected into the painful area, similar to getting a shot in the buttock. Sedation is not required. It can be somewhat painful. Applying ice to the area after the injection will reduce the pain. While the local anesthetic reduces pain, cortisone will help treat inflammation in the area.

What should I expect from the procedure?

If effective, complete relief or significant reduction in pain is expected within 2-3 weeks.

How many times can it be administered?

It can be repeated after three weeks if necessary, but if there is no benefit, repeating it may not be worthwhile. Conservative treatment with analgesic anti-inflammatory drugs and ice application should be continued.

How soon can I return to work?

You can return to work the same day immediately after the procedure. Symptoms should recede within 1-2 weeks after starting treatment. One should stay away from tennis and other racquet sports and activities that cause repetitive movements of the elbow until symptoms improve. To avoid overusing the lateral epicondyle when lifting objects, the palm should be facing upwards.

What are the risks and side effects?

Besides a temporary increase in pain for a few days after the injection, there are not many side effects.

Who should not have the injection?

Patients with hypersensitivity to the drugs used during the injection and patients on blood thinners should not have this injection.